Despite the promise of the national vaccine rollout, 2021 dawned in the middle of the deadliest four-week period of the pandemic thus far for residents of nursing homes and other long-term care settings, according to a new analysis — though the most recent set of federal data shows a consistent drop in resident and staff cases since then.
Nearly 20,000 people died from COVID-19 in institutional care settings between December 21 and January 17, the AARP Public Policy Institute determined; the advocacy group has partnered with the Scripps Gerontology Center at Miami University (OH) to track a variety of key metrics and trends associated with the ongoing pandemic in institutional care settings.
That figure works out to one death for every 51 residents, or a new four-week record since the Centers for Medicare & Medicaid Services (CMS) began compiling national nursing home COVID statistics in May.
“While the record high death rate in the four weeks ending Jan. 17 represents only a slight increase from the previous month, when 1 in every 53 residents died from COVID-19, it is more than a quadrupling of the resident death rate at the end of the summer,” AARP observed.
The analysis blamed persistently high community transmission as a major driver of the wave. Research has routinely showed that the positivity rate in a surrounding community is the most reliable predictor of outbreak risk, though facility-level factors such as staffing coverage often play a serious role in curbing — or exacerbating — outbreaks.
Staffing problems have not budged since the fall, with the average number of facilities experiencing shortages of direct care workers hovering around 29% since before Thanksgiving, though there were promising signs around access to personal protective equipment (PPE): The proportion of facilities with less than a week’s supply dropped from 19.1% on November 15 to 13.9% by mid-January, according to the AARP-Scripps analysis.
The record death toll also belies some positive news about increasing immunity in nursing homes. Infection rates among both residents and staff fell during the December-January period for the first time in months, the advocacy group noted, though the progress may simply be the result of gradual increases in herd immunity.
“So many people have already gotten COVID that we have reached a point where the pool of people in nursing homes who can get newly infected is much smaller, and this is likely contributing to the decline in new cases,” AARP study co-author Ari Houser said in a summary of the results.
The study period coincides with the start of the federal government’s nursing home vaccination program, which in theory should have begun to bear more fruit after the first round of shots was completed near the end of January. An early industry-led analysis showed that even just the first vaccine clinic helped to reduce the rate of new resident cases by 48%, significantly higher than the 21% declines seen among comparable facilities that had not yet conducted on-site inoculations; new staff infections dropped 33% as compared to 18% among facilities without vaccination clinics.
The most recent federal numbers do indeed show promise, as Harvard researcher David Grabowski observed late Thursday, with both staff and resident infections falling below the original set of late-May numbers.
Those positive trends should hopefully continue past the completion of the second round, though concerns remain over low uptake among staff — who have served as unwitting vectors of the virus, bringing it in from the surrounding community while remaining asymptomatic.
Only 37.5% of nursing home staffers opted into the first round of vaccinations, the Centers for Disease Control & Prevention (CDC) reported at the start of February, as compared to 77.8% of residents. Individual operators have logged higher numbers, though resistance and skepticism remains across a workforce that was historically underpaid and overworked even before the global pandemic turned their workplaces into epicenters of sickness and death.
In addition, while Ohio this week launched an initiative to provide ongoing clinics after the federal government’s three-round project ends, there are serious unanswered about how nursing home operators will be able to continue vaccinating new residents and staffers who may decide to opt in during the third on-site clinic.
“We now have this window and a very big gap where there is no plan. Some states are stepping in to try to create one on the fly,” Dr. Richard Feifer, chief medical officer of nursing home giant Genesis HealthCare (NYSE: GEN), told SNN last week. “But most states don’t have a plan, and we have a gap.”